Here is a picture of me eating a tropical ice “Sunday” with fruit. It was called halo halo. This was my lunch and included shaved ice on the bottom of the bowl , with a creamy liquid poured over it. Chunks of tropical fruit such as avacado’s bananas, mango’s and others, are put on top of the ice. This is then served with a scoop of purple and white ice cream of undistiniguishable flavor, and a squirt of additional fake cream… It did taste good, although sweeter than what I am used to right now. I haven’t had hardly any sugar at all here. This picture is taken in the food pavilion in the mall. Eating out is very common and cheap. The restaurants serve food that is very different from ours and have signs advertising names of dishes like squid balls, raw fish of many kinds, all manner of vegetables and sauce, whole little pigs and chickens, turning slowly over hot coals, and even hotdogs, encased in a waffle, on a stick. Rice is served everywhere, even in the “American” style restaurants serving pizza, chicken and spaghetti….even McDo’s (McDonald’s) serves rice!
This morning, right away, I started with an “almost Taxi” birth. She arrived in a taxi, but barely made it to the bed. As soon as I had her feet up and she was lying down, she started to push. No time for vitals here. Couldn’t even find heart tones…. baby was too low and on his way out.
I had just finished assisting Julia with a birth, and then ushered in a new laboring mom that was barely started contractions (her water broke). As I was starting the vitals on her (Blood pressure, temp. baby heart tones…. Ect..), I heard “Cher!” (that is what they call me here). “Laboring mom and she is pushing NOW!”
This mom was 24, and it was her 3rd baby. She was totally calm, but was obviously uncomfortable sitting in the chair on the baby’s head. As Aute’ Susan quickly, quickly, wheeled her through the back door, and over to the bed made up in the corner, I grabbed a birth cart and the oxygen tank and yanked the curtains closed around the cubicle and yanked on my gloves.
We got her up on the bed, I got the big pad under her bottom, and there was the baby’s head visible. I have really been working on head control in fast births, because after Julia’s experience with the explosion of the baby’s head out, making its own hole, I can see that head control is very, very important. I really held this head back hard, trying to get her perineum a chance to stretch and the shoulders not to blast through and make a rip. Her water broke, just as the head was crowning. There was moderately thick meconium, so I knew that they were going to want to do deep suctioning with the machine on the baby as soon as he was born. Thankfully, she did not tear. As the baby was born, he gave a good yell and pooped a bunch more on the way out. Now my bed was a mess, but I was glad to see that he was lying there safe and sound.
While the little fellow made no mistake about wanting to get out quickly, mama’s placenta took a little over a ½ hour. I was just thinking about getting some action going by getting her up into a squat on the bed, but then it came with some gentle traction. Only moderate bleeding this time. Everything looked great. I did give her a shot of pitocin, to control bleeding, since the placenta was so long in coming… (not my idea).
This mom was so strong. She wanted me to let her go home about 2 hours after the birth. All moms must stay 6 hours and this is very hard for some. Her bana came and laid down on the bed with the baby and took a nap, while she watched over them both for several hours in a hard chair by the bed. Earlier I could tell that she was definitely the one in charge here with the family. She gave him all kind of grief for the baby soap not being in the bag, and this and that, that I couldn’t understand. But the expression on his face was enough to say that he’d messed up. But, obviously she cares well for her family and gives of herself a hole bunch… letting him and baby sleep while she took the chair.
The baby was a little boy and they named him Aierl. Here is a picture of him.
Julia’s little girl that I assisted, was named Ashly Mae. Here is a picture of her, too.
Just before lunch, a woman came in that had delivered here about 6 weeks ago. She had a breast infection about a month ago and we had sent her to the doctor for antibiotics. It didn’t work. The wrong antibiotic for the wrong bacteria. Now she has huge gaping hole 3 inches across and 1 ½ deep, a crator, in her breast, where the infection has eaten away and made its way out. Milk and green pus leaks out of the hole and it looked very, very painful. The mom had not gone back to the doctor for different antibiotics, assuming that it was her fault that they were not helping. Doctors are like “God” here and they can intimidate a young mom from ever seeking further help by being rough or insulting. The breast is ruined and she will need surgery before gangrene sets in, or even tetanus. Tetanus is very rampant here, as is leprosy and gangrene. Thankfully, here at the clinic, tetanus must be current by 28 weeks, and I have given more than my share of tetanus injections these last few weeks!
Staph infections are very common, as it is on the skin at all times anyway, but it grows better here in the constant humid warmth. That is why I don’t dare break the skin on one of my mosquito bites. I carry itch medicine with me where ever I go, so that I do not scratch. An intern here last year got a septic infection from scratching a mosquito bite through the skin, and had to spend a week in the hospital (the nice one downtown, not the government one where I take moms) on IV antibiotics. That would not be a way I would like to spend my time here!
So, infections are very common in this environment. That is also why they do not allow us to do many internal exams. Back at home, we check for dilation and check for an anterior lip and a check for this and that. Here you usually only get one chance to do an internal exam and that is on admission. With it, we have to determine if there is going to be enough room for the mom’s bones to move, so the baby can come down, to see what the baby’s head is doing on it’s way out,( if it is cocked to the side), or if the baby is breech or otherwise odd presentation, if she is dilated and effaced, if the water is broken, if the tissue is healthy, and if there is going to be any problems with the decent of the baby at the vaginal opening, with the muscles and tissue at the very end. It is a lot to try to take in on a 2 minute or less exam. But they are really trying to minimize the chances for infection. Even so, they give out antibiotics with all suturing and for any other reason. They are really going through the amoxicillin and cephalahexin that I brought.
For lunch today, the cook in the clinic made a really good chicken curry, served with white rice. She had grated the coconut by hand and squeezed out the milk and cream and discarded the grated coconut meat. Then she braised the chicken pieces and added them to simmer in the coconut milk curry sauce. It is amazing to me that they do not try to cut the chicken in recognizable pieces. It is common just to chop the chicken in bite size chunks, bones and all and then just cook it that way. Everyone is always picking bones out of the side of their mouth, but that is what they do all the time with the fish they have for every meal anyway, so it looks normal. They did have fish again today and it wasn’t too salty this time. They often serve a dried fish and eat it with most meals, that is way too salty for me. I don’t mind the fishy taste, but the salt bites my tongue. This particular fish had been dried and then steamed and wasn’t too bad. It reminded me of trout, although didn’t look anything like one.
The curry today had potatoes, carrots, the coconut milk, ginger and lemon grass. I really do enjoy the curries and they never make them too spicy. Yesterday’s soup had plantains (look like banana’s but don’t really taste like them) and was thicker from the addition. Another amazing thing to me is the common practice of not refridgerating food. The cook will make a big lunch (enough for dinner too) and it will sit on the stove (with the stove off) for hours, sometimes all night and the next day, until the new food is being cooked. No one gets food poisoning. I just do not understand. I am very careful to smell the pot before I take, after Julia’s blind trust, and soured pork veggies the other day! I suppose, if one heats it up really well, that the spoil bacteria that would make me sick would be gone.
The clinic cook is a real sweet heart. She loves to please everyone and makes treats to share. She also does all the kitchen cleaning and mopping, along with making shopping lists and organizing meals. Yesterday she made little spring rolls for dinner and some of us found out about it, including me… and we snitched some from the basket as they were piping hot and so delicious. I think she was a little frustrated, as when I went back in for a drink of water from the cooler, there was a sign on the bowl with exclamation mark “This is for dinner only!” She gave me a big smile this morning when I walked in to work, so I guess she doesn’t stay mad very long.
There are other ladies that work as people who clean, ladies who do the laundry (not the bloody stuff) and keep things tidy. Sweeping, yes there is constant sweeping going on…. with shorter, whispy, wide brooms, made of a soft, fibrous plant. It is a common practice here to have household help. In fact, nationally, household help makes up for 40 percent of the jobs in the nation. Even the fairly poor have household help. Women that live with their bana’s, that are not married, are officially called housekeepers on their child’s birth certificate.
I am sitting here, with my fan blowing on me constantly and I am still sweating bunches. My skin is always sticky, my clothes are always damp from my sweat, and I cannot tell you how much I am looking forward to that air conditioned plane on the way home. For that will be the end of my stickiness.
I am off for the evening and just woke up from a nap. I am surviving by sleeping and eating when I am not working. The idea of traveling to see the famous beautiful beach doesn’t even appeal to me. Not without Tom anyway….